I had reduced-intensity (BEAM). Could that be the reason it didn't hold? - D

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There are three categories of conditioning regimens: myeloablative (high intensity), reduced intensity (intermediate intensity) and non-myeloablative (low intensity) conditioning based on the myelosuppressive effect (the duration and degree of cytopenia induced) and stem cell support requirement. Myeloablative conditioning results in prolonged, usually irreversible pancytopenia and fatal consequences unless restoration of haematopoiesis occurs following the infusion of haematopoietic stem cells (Bacigalupo et al, 2009). Myeloablative conditioning maximizes disease control and has a lower risk of relapse at the price of higher toxicity (Scott et al, 2017). Only patients below 55 years of age and without significant comorbidities assessed by comorbidity tools, such as the hematopoietic cell transplantation comorbidity index, are eligible for the myeloablative conditioning approach (Sorror et al, 2005; Sorror, 2013).

British Journal of Hospital Medicine
Vol. 80, No. 1

Haematopoietic stem cell transplants: principles and indications

Katalin Balass
Robert Danby
Vanderson Rocha

Published Online:28 Dec

Abstract

Haematopoietic stem cell transplantation was proposed as a treatment strategy just over 60 years ago. Owing to great advances in the field, haematopoietic stem cell transplantation has become an established method for the treatment of many haemato-oncological, immunological and hereditary conditions with the potential of cure. The number of haematopoietic stem cell transplants performed worldwide reached one million by 2012. This review provides an overview of autologous and allogeneic haematopoietic stem cell transplantation including disease indications, the individual steps of the procedure and outcome, and highlights achievements in the treatment of autoimmune diseases. Although autoimmune conditions account for only 1% of indications for autologous haematopoietic stem cell transplant, this is increasingly used to treat high-risk autoimmune diseases. Haematopoietic stem cell transplantation can induce long-term remission by resetting the immune system via eradication of autoreactive immune cells and the generation of a de novo self-tolerant immune system. Data seem most encouraging in multiple sclerosis and systemic sclerosis and it is likely that the number of procedures performed to treat these conditions will rise in the future.

Even though relapse remitting had the best results, this is telling in progressive MS, considering there are virtually no treatments....

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To date the largest non-randomized controlled trial report is the joint EBMT-CIBMTR study summarizing autologous haematopoietic stem cell transplantation of 281 patients between 1995 and 2006 (Muraro et al, 2017). The study included 57% of transplants for multiple sclerosis registered with EBMT or CIBMTR during the study period. The 5-year probability of progression-free and overall survival was 46% and 93% respectively. The results are remarkable considering that the majority of patients suffered from progressive disease.